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Home My WebLink AboutPermit Building 2004-03-15Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541.-726-3676Fax 541-7 26-37 69 Inspection Line FIELD Building/Combination Permit PERMIT NO: COM2004-00209ISSUED: 0311512004 APPLIED z 0212312004 EXPIRESz 1112512004VALUE: $ 11,827.20 SITE ADDRESS: 1902 8TH ST ASSESSORTS PARCEL NO.: 1703261300706 PROJECT DESCRIPTION: Extend dining room Springfield TYPE OF WORI(: Single Family Residence TYPE OF USE: Addition Residential PhoneNumber: 541-747-9069 License Expiration Date Phone Owner: Address: KINNUNEN LOUISE & EDWARI) 1902 N 8TH ST SPRINGFIELD OR 97477 Contractor Type General Electrical Contractor OWNER OWI\ER CONTRACTOR INFORMATION TION # of Units: Primary Occupancy Group: Secondary 0ccupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: # of Stories: 1 Lot Size: Height of Structure 13.50 Sq Ft lst Floor: Type of Heat: Forced Air Elect Sq Ft 2nd Floor: R-3 14.40 49.00 0.00 128 \TN Type: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: o/o of Lot Coverage: THIS P Square Footage or Bid Amount Ssft sgFtsf f'tmi6lIIS Other: F0HOccuparrt Load: Basement: L EXPIRE IF THE W Garage/CarportN Tr AU Street Improvements: Storm Sewer Available: Special Instruction: Notes: $ Per Sq Ft or multiplier 20.40 Orcgon lew rsquk$yotlto REQUIRED PARJilNG Total: Handicapped: Compact: Valuation Descrintion Description Type of Construction Page 1 of3 Value Date Calculated t -l' U rLr,rr\ G-111 I1!4(1VLU l!l1l_l Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line FIELD Building/C ombination Permit PERMIT NO: COM2004-00209ISSUED: 0311512004APPLIEDz 0212312004 EXPIREST 1112512004VALUE: $ 11,827.20 Dwellinss V Wood Frame Fee Description Plan Review Residential + l0Yo Administrative Fee + loh State Surcharge Building Permit Plan Review - Planning SDC Sanitary/Storm Admin Storm Drainage Impervious Area + l0/o Administrative Fee + 77o State Surcharge Add, Alter, Extend Circ Minimum/Adj ustment Electrical Total Amount Paid $92.40 128.00 Total Value of Project Date Paid 2t23t04 3n5t04 3n5t04 3nst04 3n5t04 3fist04 3fl5t04 5t25t04 5t2st04 5125t04 5t25t04 Receipt Number 2200400000000000167 1200400000000000318 1200400000000000318 1200400000000000318 1200400000000000318 1200400000000000318 1200400000000000318 1200400000000000799 1200400000000000799 r200400000000000799 1200400000000000799 $11,827.20 $11,827.20 02t23t2004 Amount Paid $79.9s $12.30 $8.61 $123.00 $71.00 $1.86 $37.r2 $4.s0 $3.1s $43.00 $2.00 $386.49 ['pps Pqid Plan Reviews Initial Review Planning Review Public Works Review Structural Review 02t24t2004 02t24t2004 02t24t2004 02t24t2004 02t24t2004 03t09t2004 03t09t2004 03mt2004 APP APP APP APP LLH TAJ YRJ RJB SDC fees only. To Request an inspection call the24 hour recording at 726-3769. All inspection requested before 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following work day. Footing: After trenches are excavated. Foundation: After forms are erected but prior to concrete placement. Post and Beam: Prior to floor insulation or decking. Floor Insulation: Prior to decking. Shear Wall Nailing: Before covering sheathing with finish materials. Framing Inspection: Prior to cover and after all rough in inspections have been approved. Wall Insulation: Prior to cover. Ceiling Insulation: Prior to cover. Drywall: Prior to taping. Final Building: After all required inspections have been requested and approved and the building is complete. Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. 5 6 8 4 I 7 10 2 3 1 11 red Insnecfions t2 Paee 2 of 3 Building/Combination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541 -7 26-37 69 Inspection Line PERMIT NO: COM2004-00209ISSUED: 0311512004APPLIED: 0212312004EXPIRES: 1112512004VALUE: $ 11,827.20 By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety. I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the street, that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all times during construction. Owner or Contractors Signature Date Pase 3 of3 -I I Construction Contractors Board Permit g1 C-o ut'rZ1C 'l ' O O Z-o 1 Date:zt Statement: Information Notice to Property Owners About Gonstruction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. This statement is requiredfor residential building, electrical, mechanical and plumbing permits. Licensed architect and engineer applicants, exemptfrom licensing under ORS 701.010(7), need not submit this statement. This statement will befiled with the permit. Fill in the appropriate blanks and initial boxes I and2, and either box 3A or 38: v l. I own, reside in, or will reside in the completed structure. 2 I understand that I must become licensed as a construction contractor if the structure is sold or offered for sale before or on completion. (ccB #) I will instruct my general contractor that all subcontractors who work on the strucfure must be licensed with the Constnrction Contractors Board. OR EI- rg. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is licensed with the CCB and will immediately notiff the office issuing this building permit of the name of the contractor. I hereby certify that the above information is correct and that I have read and do understand the Information Notice Construction Responsibilities on the reverse side of this form. 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-3784621 WebAddress:ry$t3!4 Address: i?OL #1"- >f Issued by:\s c el u 'q-W 5- -L;^'04 of applicant) (White copy to issuing agency perrnitfile, pink copy to applicant.) @ate) Property_owner.doc 03/ I I /03 tr 3A. My general contractor t, ^._, Acting as Your Own General Contractor? INFORMATION NOTICE TO PROPERTY OWNER$ ABOUT CONSTRUSTION RESPONSIBILITIES JVOfE: This lnfr.rnatian Natice to Property Owners about Canstructian Responsibi/lties was d*veloped by the Construcfion Cantractors Board in accordance with ARS 7U.A55{51, pasoed by the 1989 Orogan Legislature. If you are acting as your own conffactor to construct a new home or make a substantiaf improvement to an existing skucture, you can prevent many problems by being aware of the follorving responsibilit"ies and corcerns. Employer Responsibilities You will, in most instances, be ruled tei be an "employer" and the contractors you contract with will be "employees" if you use contractors not licensed w'ith the Construction Contractors Board to do labor in constructing or to assist in the construction or improvement of a residential structure. As the employer, you must comply with the following: Oregon's Withholding Tax Law: As an employer, you must withhold income taxes &orn employee wages at the time emplnyees are paid. You will be liabie for the tax payments even if you don't actually withhold the tax from ycur employees. For a State Business ID number, call the Business lnformation Center at 503-986-2200. Unernployment Insurnnce Tax: As an employel, you are required to pay a tax for unemployment insurance purposes on the wages of all ernpioyees. For more information, call the Oregon Employment Department $ 5A3-947-1488. Workers' Compensation lnsurance: As an ernployer, you are subject lo the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation insurance, you could be subject to penaities and be liable for all claim costs if one of your employees is injured on thejob. For more information, call the Workers' Compensation Division at the Department of Consumer and Business Services at 503-947-7815. U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from employees' wages. You will be liable for the tax payment even if you dida't actually withhold the tax. For a Federal EIN number, call the - l\'IRS at 866-8 I 6-2065 or fax them at 801 -620-7 I 1 5. Other Responsibilities and Areas of Concerns Code Compliance: As the permit holder for tliis project, you are responsible for resolving any failure to meet code requirements that may be brought tb your attelrtion through inspections. Liability and Property Damage fnsnrance: Contact your insurance agent to see if you have adequate insurance coverag€ for accidents and omissions such as falling tools, paint over spray, water damage from pipe punctures, fire or work that must be redone. Time: Make sure you have sufficient time to supervise your employees. Expertise: Make sure you have the skills to act as your own general conhactor, to coordinate the work of rough-in and finish trades, and to notifu building officials as the appropriate tiines so they can perform the required inspections. If you have additional questions call the Construction Contractors Board (503-378-4621) or write the agancy at p0 Box 14140, Salem, OR 97309-5052. Properfy_owner.doc 03i I 1 /03 225 FIFTH STREET . SPRINGFIELD, OR97477 o PH:(541)726-3753 o FAX: (541)726-3689 E LECTKICAL P E RM IT AP P LI CATI O N City Job Number Cnu,t< Zo O1 *ct C Z C) ? Date S o\z5- 1 LO CAr' I ON O T' IN STEU-E?ION tq,.'t c+L- .. li-Itt-C- I> >r LEGAL DESCRIPTION t-7 03 z6( 3 c)o"c6 3. COMPLETE A. }er Rcsidential - Service Included 1000 sq. ft. or less $ r 06.00 19.00 ONED FOR $ 63.00 $ 75.00 $ 12s.00 $163.00 75.00 50.00 $ s0.00 $ 69.00 $ 100.00 above. $ 43.00 $ 3.00 E;:",i3y,, JOB DESCRIPTION Ass I C < (Lc.'-rC Each additional portion thereof 500 SH sq. ft. or llffi,g-TIIHIS P Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. 7 Electrical Contractor Address Supervisor License Expiration Date Constr. Contr, of Supervising Electrician ND 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps ltpgo rut€8 the 1 20r Amps 401 Amps to 600 Amps Over 600 Amps or 1000 Volts see "B" Pump or irrigation Sign/Outline Lighting Limited Energy/Residential Limited Energy/Commercial Minimum Electric Permit Inspection Each Manufact' S(TBTOTAL AF ABOW 7o/o State Surcharge l0% Administrative Fee TOTAL 80 DAY P ERIO $s0.00 C O NT RACT O R I N S TAL IATION OATI I'B. Services or Feetlers - Installation, Allerations or Relocation: City @e0. D. Branch Circuits New Alteration or Extension Per Panel One Circuit I Each Additional Circuit or with Service or Feeder Permit E. N'Iiscellaneous (Servicelfeeder trot included) -Each lnstallatiou U< T. Owners Name Address (_N lQaz-I s /ru€I<{ D phone 7 4a 7061 OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners $ 50.00 $ 50.00 $ 25.00 $ 45.00 Surcharges L({ lA/Ur"3lf Y)" 9 ZGfInspection Request: 726-3769 4. Shared Drive(T:)/Building Fonns/Electrical Pemit Application I -03.doc CITY OF OREGON I 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone ruty of Springlield Oflicial Receipt .velopment Services Department Public Works Department RECEIPT #: 1200400000000000799 Date: 0512512004 10:46:14AM Job/Journal Number coM2004-00209 coM2004-00209 coM2004-00209 coM2004-00209 Description + 7Yo State Surcharge + l0% Adminishative Fee Add, Alter, Extend Circ Minimum/Adjustment Electrical Amount Due 3.15 4.50 43.00 2.00 Item Total:$s2.6s Payments: Type of Payment Paid Bv CheckNumber Authorization Received By Batch Number Number How Received Amount Paid Check LOUISE LANE djb 1239 In Person $52.65 Payment total: -Sffi 5/25/2004 Page I of I 'HmmI} ,. F Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line Building/C ombination Permit PERMIT NO: COM2004-00209ISSUED: 0311512004 APPLIED z 0212312004 EXPIRES: 09/1512004VALUE: $ 11,827.20 SITE ADDRESS: 1902 8TH ST ASSESSOR'SP$RCELNO.: 1703261300706 PROJECT DESCRIPTION: Extend dining room Springfield TYPE OF WORK: Single Family Residence TYPE OF USE: Addition Residential Phone Number: 54l-747-9069 License Expiration Date Phone Owner: Address: KINNUNEN LOUISE & EDWARD 1902 N 8TH ST SPRINGFIELD OR 97477 Contractor Type General Contractor OWI\ER CONTRACTOR INFORMATION IILDING INFORMATION # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: SETBACKS Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: # ofStories: 1 Height of Structure 13.50 Type of Heat: Forced Air Elect Water Type: Range Type: Energy Path: Path I Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Impervious Surface Area: 128 L EXPIRE IF THE WOR R THIS PERMIT IS NO i ABANDONED FOR 0D. Date Calculated 02t23t2004 R-3 \rN 14.40 Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: o/o of Lot Coverage: $ Per Sq Ft Square Footage or multiplier or Bid Amount $92.40 128.00 Total Value of Project Page I of3 REQUIRED PARKING Total: Handicapped: Compact: 49.00 0.00 20.40 ilOTICE: A follow rules adopted Street ImproYemen$Otil ication Center. Those es are Storm Sewer .c.vaitain0AR 952-001-0010 throu gh oAR 952-001 Special Instruction:0090. You maY obtain copies of the rules b) calling the cente r. (Note: the telePhone Notes:n umbelforthe oreg on UtilitY Notification Center is 'l'800-332'-2344) HIS PERMIT SHAL Sidervalk NDE Value $11,827.20 $11,827.20 Description Dwellings Type of Construction V Wood Frame .:L.Ll L,I,VtlL(rrlYlEl\ t tt\r(rr1luArr\rr\ | Valuation Description Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line PRIN Building/Combination Permit PERMIT NO: COM2004-00209ISSUED: 0311512004 APPLIEDT 0212312004EXPIRES: 09/1512004VALUE: $ 11,827.20 Fees Paid Fee Description Plan Review Residential + l0%o Administrative Fee + 7oh State Surcharge Building Permit Plan Review - Planning SDC Sanitary/Storm Admin Storm Drainage Impervious Area Total Amount Paid Amount Paid $79.9s $12.30 $8.61 $123.00 $71.00 $1.86 $37.12 $333.84 Date Paid 2t23t04 3ltsl04 3nst04 3nst04 3n5t04 3n5t04 3n5t04 Receipt Number 2200400000000000167 1200400000000000318 1200400000000000318 1200400000000000318 1200400000000000318 1200400000000000318 1200400000000000318 Plan Reviews Initial Review Planning Review Public Works Review Structural Review 02t24t2004 02t24t2004 02t24t2004 02t24t2004 02t24t2004 03t09t2004 03t09t2004 03nU2004 APP APP APP APP LLH TAJ VRJ RJB SDC fees only. To Request an inspection call the 24 hour recording at 726-3769. AII inspection requested before 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following work day. I Footing: After trenches are excavated. 2 Foundation: After forms are erected but prior to concrete placement. 3 Post and Beam: Prior to floor insulation or decking. 4 Floor Insulation: Prior to decking. 5 Shear Wall Nailing: Before covering sheathing with finish materials. 6 Framing Inspection: Prior to cover and after all rough in inspections have been approved. 7 Wall Insulation: Prior to cover. 8 Ceiling Insulation: Prior to cover. 9 Drywall: Prior to taping. 10 Final Building: After all required inspections have been requested and approved and the building is complete. Reorrired Insnecfions Paee 2 of 3 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541 -7 26-37 69 Inspection Line Building/Combination Permit PERMIT NO: COM2004-00209ISSUED: 0311512004APPLIEDz 0212312004EXPIRES: 09/1512004VALUE: $ 11,827.20 By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety. I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the street, that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all times during construction.g 5-o or Contractors Date Page 3 of3 \L}.l JOURNAL OR JOB NAME OR COMPANY: LOCATION: TAX LOTNUMBER: DEVELOPMENT TYPE: NEW DWELLING UNITS I. STORM DRAINAGE DIRECT RTINOFF TO CIry STORM SYSTEM CITY OF SPRINGFIELD SYSTEMS DEVELOPMEN'I WORKSHEET Com2004-00209 1902 8th Street 17032613 706 SFD Addition 0 BUILDING SIZE LOT SrZE (SF):0 IMPERVIOUS S.F. x 128.00 RT]NOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS IMPERVIOUS S.F 0.00 NUMBER OF DFU'S 0 B. IMPROVEMENT COST: NLMBER OF DFU's 0 ADTTzuP RATE 9.57 B. IMPROVEMENT COST: ADT TRIP RATE 9.57 SUBTOTAL $37.t2 COST PER S.F s0.290 COST PER S.F s0"290 COST PER DFU s22.64 COST PER DFU st7.2t NUMBER OF LTNITS 0 NUMBER OF LINITS 0 ADM. FEE RATE 5% CHARGE $37.12 DISCOUNTRATE s0% s37.12 DISCOUNT $0.00 x x x x x x ITEM 1 TOTAL - STORM DRAINAGE SDC A. REIMBURSEMENTCOST: ITEM 2 TOTAL - CITY SANITARY SEWER SDC $0.00 3. TRANSPORTATION A. REIMBURSEMENTCOST: xxCOSTPER TRIP s17.23 COST PER TRIP s76.01 $0.00 NEW TRIP FACTOR 1.00 NEW TRIP FACTOR 1.00 xx ITEM 3 TOTAL - TRANSPORTATION SDC A. REIMBURSEMENTCOST: NUMBER OF FEU's 0 B. IMPROVEMENT COST: NUMBER OF FEU's 0 MWMC CREDIT IF APPLICABLE (SEE REVERSE) MWMC ADMINISTRATIVE FEE ITEM 4 TOTAL - MWMC SANITARY SEWER SD( = SUBToTAL (ADD ITEMS 1,2,3, & 4) $0.00 s37.r2 CHARGE $1.86 x TOTAL SANITARY ADMINISTRATION FEE: TOTAL TRANSPORTATION ADMINISTRATION FEE: Virginia Jurasevich 31912004 COST PER FEU s314.63 $37.12 $0.00 $0.00 $38.98 I 070 l09l 1092 I 093 1094 1055 I 054 1056 aao \J O & E]Fa E]& COST PER FEU s214.23 PREPARED BY DATE TOTAL SDC CHARGES x DRAINAGE FIXTURE UNIT CALCULATION TABLE NUMBER OFNEW FIXTURES x LINIT EQUIVALENT: DRAINAGE FXTURE UNITS FOR REMODELS, CAI-CULATE ONLY TI{E NET ADDITIONAL NO. OF FIXTURES T]NIT FIXTURE TYPE NEW OLD ALENT MISCELLANEOUS DFU TYPE NUMBER OF EDU'S TOTAL DRAINAGE FIXTURE UNITS lsa toa unit set at 167 MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE 20 DRAINAGE FIXTURE 0 +EDU 0 0 3 0BATHTUB 0 0 1 0DRINKING FOUNTAIN 0 3 00FLOOR DRAIN 0 0 3 0INTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC. 0 0 6 0INTERCEPTORS FOR SAND i AUTO WASH / ETC. 2 000LALTNDRY TUB 0 0 3 0CLOTHESWASHER / MOP SINK 0 0 6 0CLoTHESWASHER - 3 OR MORE (EA) 0 12 00MOBILE HOME PARK TRAP (I PER TRAILER) 0 0 1 0RECEPTOR FOR REFRIG / WATER STATION / ETC. 0 0 3 0RECEPTOR FOR COM. SINK / DISHWASHER / ETC. 0 2 00SHOWER, SINGLE STALL 0 0 2 0SHOWER, GANG (NUMBER OF HEADS) 0 0 3 0SINK: COMMERCIAL/RESIDENTIAL KITCHEN 0 2 0SINK: COMMERCIAL BAR 0 0 0 2 0SINK: WASH BASIN/DOUBLE LAVATORY 0 0 1 0SINK: SINGLE LAVATORY/RESIDENTIAL BAR 0 0 5 0UzuNAL, STALL/WALL 0 0 6 0TOILET, PUBLIC INSTALLATION 0 3 0TOILET, PRIVATE INSTALLATION 0 0 YEAR ANNEXED CREDIT RATE/$I,OOO ASSESSED VALUE IS LAND ELGIBLE FOR ANNEXATION CREDIT? (Enter I for Yes, 2 for No) IS IMPROVEMENT ELGIBLE FOR ANNEX. CREDIT? (Enter I for Yes, 2 for No) BASE YEAR 0 0 1979 CREDIT FOR LAND (IF APPLICABLE) VALUE/ IOOO CREDITRATE 50.00 x $5.04 CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION) VALUE/ lOOO CREDITRATE $0.00 x $s.oa TOTAL MWMC CR.EDIT I so.oo BEFORE I979 $5.04 1979 $5.04 I 980 $4.95 t98t $4.88 1982 $4.75 1983 $4.5 8 1984 $4.41 I 985 $4.20 1986 s3.88 1987 $3.50 1988 $3.07 I 989 $2.60 1990 $2.1 4 t99l $ l.7l t992 $ 1.52 l 993 $ 1.38 1994 $ l.l9 I 995 $1.03 1996 $0.87 1997 $0.68 1998 s0.46 1999 $0.27 2000 $0.09 2001 s0.04 l-- 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department #: 1200400000000000318 Date: 0311512004 9:30:00AM coM2004-00209 coM2004-00209 coM2004-00209 coM2004-00209 coM2004-00209 coM2004-00209 Storm Drainage Impervious Area SDC Sanitary/Storm Admin Plan Review - Planning Building Permit + 7Yo State Surcharge + ljY, Administrative Fee Item Total:$2s3.89 37.12 1.86 71.00 123.00 8.61 12.30 Type of Payment Paid By Received By Batch Number Authorization Number How Received Amount Paid Check LOUISE F LAINE dlm t43l In Person Payment Total: $2s3.89 $253.89